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Vulvovaginitis, a common condition for which women seek medical care, accounts for greater than 10% of visits made to providers of women's health care. It is characterized by symptoms that cause itching, irritation, burning, and abnormal vaginal discharge. The three most common causes of vaginal discharge in women within the reproductive age group are bacterial vaginosis, candida vulvovaginitis, and trichomoniasis. All patients with vulvovaginitis present with common symptoms like vaginal discharge, itching, and dysuria. Diagnosis of vulvovaginitis requires a detailed history of the patient's symptoms, as well as her sexual history, both of which facilitate an accurate diagnosis. Physical examination of the external genitalia and speculum examination should focus on documenting the nature of the discharge, the presence of any vulvar or labial lesions, foreign body, presence of cervical inflammation, cervical lesions, and any cervical motion or adnexal tenderness with a bimanual examination. It is essential to rule out pelvic inflammatory disease and cervical lesions as the cause of vaginal discharge. Estimation of vaginal pH and vaginal smear wet mount examination constitute the initial diagnostic test, which helps differentiate among common etiologies. Treatment of vulvovaginitis includes medical therapy targeted against the causative pathogen and counseling on hygiene, voiding techniques, and sexual practices. The prognosis is good in most patients, though a minority of patients experience recurrence.
Based on the etiology vaginitis is classified into the following:
The differential diagnosis for patients presenting with vaginal discharge includes the following considerations:
|Common Presentation||Disease||Symptoms||Physical Examination Findings|
|Discharge||Dysuria||Vaginal odor||Dyspareunia||Genital skin lesion||Genital pruritus|
Diagnosis and Treatment
|pH||Saline Wet mount preparation||Gold Standard test|
|Candida Vulvovaginitis||Normal||Hyphae and pseudohyphae can be demonstrated||Culture|
|Bacterial Vaginosis||>4.5||Clue cells are demonstrated||Gram stain to determine the relative concentration of lactobacilli, Gardnella vaginalis, Prevotella, Porphyromonas, peptostreptococci and Mobiluncus||
Amsel’s criteria: Presence of three out of four criteria is required to make the diagnosis of Bacterial Vaginosis
|Trichomoniasis||>4.5||Nucleic acid amplification test (NAAT)|
|Atrophic Vaginitis||Normal||Vaginal smear cytology shows increased parabasal cells||Leftward shift of the vaginal maturation index||
|Numerous leukocytes are present||No gold standard confirmative test but excessive growth of aerobes on culture helps in diagnosis when the vaginal smear findings are indeterminate||Microscopic diagnosis is made by Lactobacillus grade (LBG) and the severity is scored based on number of leukocytes, proportion of toxic leukocytes and parabasal epitheliocytes, and background flora|
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